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PERMITTEE NAME;ADDRESS,b,: n„A Facihn Yana b anan it Di/)errntl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION /DF N l <br />'F- 'J !', 1' t!l A' 'P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No 20404)004 <br />PERMIT NUMBER DISCHARGE NUMBER t <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE; Reed Instructions before comoletino this form. <br />PARAMETER QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />I <br />NO. <br />FREQUENCY SAMPLE <br /> <br />EX OF <br />TY <br /> PE <br />ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS I <br /> SAMPLE <br />MEASUREMENT <br />/ <br />JCa <br />V <br /> Y v <br />?? <br /> PERMIT = R#sr R lR t - it sr sr sli i`..? % <br /> REQUIREMENT <br />:NT.-i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME.,TITLE PRINCIPAL EXECUTIVE OFFICER I cemF, under pennlh „r law that tin, &wurnent and all attachments were TELEPHONE DATE <br /> prepared under my direction or :ulxn•isinn it, deamhtncc wath a system ,lesig. ned <br /> i,- a4surc that lualified Nrxrnncl properic gather :md evaluate the inlommtion ` <br /> 'uhmttt,lL Ha,ed cm my inquire of the pery,n ar person.' w.hu •nanage the system, <br /> or those persons dirc:tly resrtonsthle for gathenng the Information. the Information <br /> uhmitt•_•1 I< to the st of my kit t le <br />a <br />dad behcl. true. accurate. <br />fu <br />complete. <br />' <br />h <br />f SIGNAT RE OF PRINCIPAL EXECUTIVE 1 <br /> n <br />l <br />r <br />irr <br />In, <br />.nt me <br />itanant penahies for std?maring lake e mf.'mtatlon, <br />.hat t <br />ere e arc slem <br />TYPED OR PRINTED L. n,din.In :ix possthdrty of fine ant, nnprtsonmcut lot knowvtg croimu,2 OFF ER OR AUTHORIZED AGENT NUMBER <br />COD YEAR <br />R MO DAY <br />n nuuruTn w E _ <br />?..-? ?... r.-....-.. ..... .•,. ,-.... ..v.r..v.?.a Inctc?cra t.c mt auoa.rnncttw nor c/ <br />PR EC IF <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. Dis ma 4-pail form.